Key result
A 55-year-old male with severe systolic heart failure and new-onset Graves' disease developed refractory atrial fibrillation and subsequent ventricular fibrillation, successfully terminated using atrial overdrive pacing.
Case Report (n=1)
Atrial overdrive pacing can successfully terminate refractory torsade de pointes and ventricular fibrillation in a patient with severe heart failure and new-onset thyrotoxicosis exacerbated by amiodarone.
Case of post-cardioversion torsades in thyrotoxic HF highlights QT monitoring needs; leaves open optimal rate-control approaches in refractory AF.
This case involves a 55-year-old male patient with systolic heart failure and refractory atrial fibrillation due to thyrotoxicosis, who was electrically cardioverted but then developed torsade de pointes and ventricular fibrillation. Rate control was unsuccessful with digoxin, cardizem, labetalol, esmolol and amiodorone. Patient was externally cardioverted after which ECGs showed prolonged QT with frequent premature ventricular contractions. ECGs also showed 'R-on-T' phenomenon leading to torsades and ventricular fibrillation. Atrial overdrive pacing was used to terminate the dangerous arrhythmia and the patient returned to sinus rhythm. Interestingly, he was found to have new onset thyrotoxicosis and started on methimazole.
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Cho et al. (2019) conducted a case report in Ventricular fibrillation, Graves' disease, amiodarone induced thyrotoxicosis (n=1). Amiodarone and other rate control medications in the setting of thyrotoxicosis was evaluated. A 55-year-old male with severe systolic heart failure and new-onset Graves' disease developed refractory atrial fibrillation and subsequent ventricular fibrillation, successfully terminated using atrial overdrive pacing.
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